Wednesday, 30 July 2014

This is synopsis of lecture by Dr. Sharda Jain presented as public lecture series at DMA (July 2014).Advances in cancer treatment and improved prospects of survival after cancer treatment call for greater importance to be laid on patients quality of life & an aspect of Fertility Preservation in both sexes.Cancer treatment has significant association with future fertility of patients as it causes testicular / ovarian dysfunction which is as the most common side effect of chemo therapy.Gonadal toxicity was first reported in 1948, involving testicular damage by nitrogen mustard (Chemotherapeutical drugs). The first report of Gonadal toxicity in women was in 1956 and this was associated with busalfan treatment of chroninc myeloid leukemia. Freezing sperm become a practical proposition only after the discovery of the cryoprotective property of glycerol, 53 years ago. The first infants born from frozen semen is now over 50 year old.

Recently significant progress has occurred in female fertility preservation using embryo cryopreservation, human oocyte cryopreservation, and gonadal tissue cryopreservation. Perhaps most significantly, all these developments, along with the rapid development in the field of IVF , have found human application in day today practice without any clinical trials, giving an added urgency to the public awareness & need to be involved in the issues surrounding social , ethical, moral and legal debate on fertility preservation.Clinicians need to be aware of the importance of offering sperm banking facilities, as denial can result in litigation. It is good that the practitioners do understand not just the technical and clinical aspects of procedures, but also to develop a deep sense of social responsibility towards children, adolescent & young adult with cancer together with an equivalent level of understanding of the legal, moral and ethical issues related to it.

Thursday, 27 February 2014

Role of Semen Preparation Techniques in Success of IUI – Where and How?

Dr. Aruna Saxena ,Dr. Sharda Jain, Dr. Jyoti Bhaskar, Dr.Jyoti Agarwal, Dr. Abhishek PariharIntrauterine insemination is accepted as the most common first therapeutic intervention in Infertile couples. It can be performed with or without ovarian stimulation for treatment of cervical factor, mild to moderate male factor, anovulation and unexplained infertility.Big part of the success of IUI lies in semen processing. The semen preparation which is offered as IVF services in Delhi to IVF patients is now universally followed for IUI patients too. It has eliminated the risk of pelvic inflammatory disease and uterine cramping.The aim of semen preparation is to separate the normal sperm from the debris of the ejaculate and in case of IUI, to yield as many normal motile spermatozoa as possible.It is important to remember that for the best results of IUI, Semen preparation should be done in In house Lab and should not be processed outside – as sperm capacitation process starts immediately and inspite of motile sperms, no pregnancy results.We are 30 thousand gynaecologists in India and nearly half of them are practising infertility and doing IUI. It is unfortunate that except in IVFcentres in Delhi Ncr– very few gynaecologists in Delhi have In house lab for semen preparation.

As far as the technique of sperm preparation is concerned – it is clear one size does not fit all.Spermatozoa may be selected by their ability to swim, known as the 'swim-up technique'. This technique is performed by layering culture medium over the liquefied semen. Motile spermatozoa swim up into the culture. The upper part of the layered medium is then carefully removed for further use.

The second method of selecting spermatozoa is by the use of density gradients. The semen sample is pipetted on top of the density column, which is then centrifuged. Density gradient centrifugation separates spermatozoa according to their density. This way we can select the motile, morphologically normal spermatozoa in the solution with the highest concentration of gradient, which is aspirated for further use.

The third method is conventional wash method in combination with centrifugation. The semen sample is diluted with a medium and centrifuged. Subsequently, the pellet (the bottom part after centrifugation) is resuspended in a small amount of medium and incubated until the time of insemination.

It is our experience at Lifecare IVF, a reputed IVF centre in Delhi Ncr, that there is no statistically significant difference between pregnancy rates for swim up versus gradient /wash technique though results from various studies may suggest a preference for gradient technique for most of the samples. Only samples with very good parameters should be prepared by Swim up technique.

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According to a recent survey by TOI in August 2013, out of the
world's 100richest people today, 27 are Heirs (Inherited) and 73 are Self
made. These super achievers are not born rich but are self made people. It is not
external favour that makes one a super achiever, but one's own efforts and self
acquired success.

There is a saying that Mr. X was born with a silver spoon in his
mouth. This kind of inheritance creates in the concerned person and kills the motivation.

In
contrast, a child born in a poor family, not sure if he will get the next meal, develops
a kind of discontentment and hunger that kindles a
fire within him to work hard. Living examples
next to you are Mr. Narender Modi, Mr. Kejariwal, Dr.
Walia, Dr. Harshwardhan, Dr. Sharda Jain and Dr. Vinay Agarwal whom you all know.

The
Law of nature is greater and more strict than everything else.

They are Eternal!
They cannot be Changed!

The
Law is - “It is not ease but effort, Not facility
but difficulty – that makes an